Provider Demographics
NPI:1326710930
Name:COOPER, AMANDA E
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:COOPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 CENTRAL PARK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6518
Mailing Address - Country:US
Mailing Address - Phone:254-218-4478
Mailing Address - Fax:
Practice Address - Street 1:7710 CENTRAL PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6518
Practice Address - Country:US
Practice Address - Phone:254-218-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health